Mayerlin Hernandez, pictured with daughter Anmary, says she cannot imagine achieving her breastfeeding goal without the support of the Brigham’s Mama Sana program, which provides breastfeeding and nutrition counseling in Spanish.

Even from the early days of her pregnancy, Mayerlin Hernandez knew she wanted to breastfeed her baby. In preparation, she tried to immerse herself in the topic at home — reading articles and watching videos about breastfeeding positions, breast pumps to support lactation and other strategies to make the process go smoothly.

“I was always trying to educate myself,” she said. “Even though lactation is natural, you still have to learn.”

But, like many mothers, Hernandez encountered challenges with breastfeeding after the birth of her daughter, Anmary, at the Brigham in February. As she recovered from a cesarean delivery, she struggled to find a comfortable way to nurse her baby without aggravating the tender area around her incision. When her daughter latched to her breast to feed, it was unexpectedly painful.

As the breastfeeding experience Hernandez had envisioned seemed to evaporate before her eyes, she began to get discouraged. The challenges she experienced, however, are extremely common, and most women who wish to continue nursing can receive support from an international board-certified lactation consultant (IBCLC) or a certified lactation counselor (CLC) to help them and their babies work toward their goal.

But for patients who have limited or no proficiency with English — like Hernandez, who is a Spanish speaker — a language barrier can make breastfeeding support feel inaccessible or simply too overwhelming when their providers only speak English.

That dynamic shifted when Elena Padilla Garza, RD, LDN, CLC, a bilingual dietitian and certified lactation counselor, entered Hernandez’s hospital room and greeted her not with a “hello” but an “hola.”

“From the moment I first spoke with Elena — and I knew that she spoke Spanish and understood me — I felt very calm,” Hernandez said. “It wasn’t because the other providers didn’t want to help, but we had to wait for a tablet or a second person to come in to interpret.”

Padilla Garza’s presence in the room was no coincidence. She is part of the team supporting Mama Sana, a Spanish-language nutrition and breastfeeding program at the Brigham that seeks to improve breastfeeding support and health outcomes for Spanish-speaking birthing patients and their babies.

The program is one of several ways the Brigham seeks to deliver equitable care to patients with limited English proficiency, complementing an Interpreter Services team that provides interpreting in 30 languages to mothers throughout their pregnancy and clinical encounters with caregivers to ensure a healthy delivery.

“Breastfeeding is a unique clinical situation,” said neonatologist Sarbattama (Rimi) Sen, MD, director of Faculty Development in the Department of Pediatrics and a co-founder of the program. “There are so many physical as well as nonverbal cues that go into successful breastfeeding. The physical presence of someone who not just understands the language but also understands those cues serves an important purpose.”

Closing Gaps

The multidisciplinary program, whose name translates to “Healthy Mom,” was established in early 2022, but the conversations that inspired it go back several years prior.

“As we saw racial inequities and gaps in care become very evident during the pandemic, we determined it was going to be important to look at the data we had with respect to breastfeeding,” said fellow Mama Sana co-founder Anne CC Lee, MD, MPH, director of Global Newborn Health in the Department of Pediatrics. “We first noticed rates of exclusive breastfeeding were lowest among publicly insured patients. When we examined it further, we saw the rates were lowest of all among Hispanic Spanish-speaking populations.”

The contrast was startling: Upon discharge from the hospital after childbirth, about half of white non-Hispanic patients were exclusively breastfeeding. Among those who identified as Hispanic and Spanish-speaking, only about one in five were exclusively breastfeeding at discharge.

“There’s so much that can get lost in translation because the language you use for breastfeeding counseling is very niche,” says Elena Padilla Garza.

As the team investigated further, they found the disparity wasn’t due to cultural preferences.

“When you look at Hispanic women who come to the Brigham, about 80 percent express their desire to breastfeed at admission,” Lee said. “There was a large gap between what mothers wanted and the outcomes as they left the hospital.”

With backing from department leadership, Mama Sana was established to provide breastfeeding support in Spanish during and after pregnancy. The program seeks to provide “wrap-around” care, offering not just in-hospital lactation counseling in Spanish but also group prenatal classes and one-to-one postpartum support around breastfeeding and nutrition.

“Our interpreters are absolutely phenomenal, but what moms have told us is they don’t ask as many questions because they know it’s going to take more time to communicate,” Padilla Garza said. “With breastfeeding counseling, we also spend a lot of time on visual feeding cues, which are difficult for an interpreter to understand and convey if they’re participating virtually or on the telephone. In addition, there’s so much that can get lost in translation because the language you use for breastfeeding counseling is very niche.”

For patients with complex needs, Padilla Garza works closely with nurses and IBCLCs, who undergo more intensive training in clinical management of breastfeeding.

Despite Mama Sana’s limited resources — it currently functions as a consult service for patients considered to be at high risk for a poor lactation outcome — there are signs that the program is making a difference. Now, three out of four Spanish-speaking patients who give birth at the Brigham have access to Spanish-language lactation support. To date, Mama Sana has served more than 300 patients.

Culturally Concordant Care

Members of the Mama Sana team emphasize that language is only one part of the equation.

“There’s also the cultural piece,” explained Padilla Garza, who is originally from Mexico and has enjoyed the opportunity to learn more about different practices throughout Latin America. “We have many patients from the Dominican Republic, and a common myth there is that you should not have raw vegetables, avocado or coconut while breastfeeding, which is not supported by evidence and could affect the patient’s diet. If you’re not familiar with that culture, however, that’s not something you would think to mention or address.”

Lee added that having a care provider with a similar cultural background — a concept known as culturally concordant care — can help establish trust and confidence during a vulnerable time. This includes members of the clinical team, medical interpreters and other staff involved in patient care.

“Studies that have shown when caregivers speak the same language and come from a similar cultural background, patients feel they can trust them. They have a better therapeutic alliance,” Lee said. “Patients feel welcome and at home when those taking care of them understands them.”

As for Hernandez — who is continuing her breastfeeding journey with her now 5-month-old daughter — she hopes Mama Sana receives the resources it needs to grow so that more mothers can have the same experience.

“Sincerely, I would not be breastfeeding if Elena never visited me that second day in the hospital,” she said.